Basic Information
| Provider Information | |||||||||
| NPI: | 1518294057 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUELLER | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | P.A.-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WEBER | ||||||||
| OtherFirstName: | DEANNA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1006 NEW MOODY LN | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400319122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025930083 | ||||||||
| FaxNumber: | 5022220029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 NEW MOODY LN | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400319122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025930083 | ||||||||
| FaxNumber: | 5022220029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2009 | ||||||||
| LastUpdateDate: | 08/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.